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General NPI Number Information
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NPI Number | 1750888376
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Entity Type | Individual
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Provider Name | SHANE LESLIE LEIGHTON MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 130 DIVISION ST
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City | DERBY
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State | CT
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Zip | 06418-1326
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Country | US
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Telephone | 203-735-7421
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Fax |
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Provider Business Mailing Address
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Address Line | 18840 NW 24TH CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-5354
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Country | US
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Telephone | 772-321-1119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | S9734
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 69210
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License Number State | CT
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